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Article
Mental Retardation in Children,Causes &Prevention

Author: Zuhair M. Al-Musawi
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2007 Volume: 2 Issue: 3 Pages: 30-37
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

This study was conducted to know the definite & probable causes of mental retardation (M.R.) in children & how can we prevent some of the cases.
Three hundred eighty three children with moderate to severe (M.R.) were studied in Kerbala Pediatric Hospital over two years from January 2003 to January 2005.
The male to female ratio was 1.51:1. The etiology was known in151 patients (39.4%) & was unknown in 232 patients (60.6%).
The probable preventable causes include kernicterus, hypoxic ischaemic encephalopathy, severe malnutrition, prematurity neonatal sepsis, hypothyroidism, encephalitis, meningitis, neural tube defect, galactossaemia, shaken baby syndrome & lead poisoning, constituting (68.8%) of the known probable causes.
There was a high rate of consanguinity of parents, (37.8%) were first cousin, (24.8%) were relatives while (37.4%) were not related.
Three hundred forty eight patients (90.88%) were diagnosed before their first birthday.
It was concluded from the study that we can help to reduce cases of (M.R.) by practicing primary & secondary prevention through health promotion, specific protection; early diagnosis & treatment of treatable disorders by neonatal screening program.

أجريت هذه الدراسة لمعرفة الأسباب المؤكدة و المحتملة للتخلف العقلي و كيفية الوقاية من قسم منها.ثلاثمائة و ثلاث وثمانون طفل مصاب بالتخلف العقلي المتوسط و الشديد تمت دراسته في مستشفى كربلاء للأطفال خلال سنتين للفترة من كانون الثاني 2003 إلى كانون الثاني 2005. كانت نسبة الذكور إلى الإناث 1:1.51، وكان السبب معروفا في 151 طفلاً (%34.4) و غير معروف في 232 طفلاً (%60.6). الأسباب المحتمل إمكانية الوقاية منها شملت اعتلال الدماغ نتيجة ارتفاع المادة الصفراء في الدم، اعتلال الدماغ نتيجة نقص الأوكسجين، سوء التغذية الشديد، الخداجة، تسمم الدم الجرثومي، نقص إفراز الغدة الدرقية، التهاب الدماغ، التهاب السحايا، نقص في الأنبوب العصبي، كالكتو سيميا، متلازمة ارتجاج الطفل و التسمم بالرصاص، و التي كونت (%68.8) من الأسباب المحتملة للتخلف العقلي. كانت هنالك نسبة عالية من القرابة بين الأبوين. (%37.8) منهم أولاد عم, (%24.8) أقارب من الدرجة الثالثة و الرابعة و (%37.4) ليسوا أقارب.ثلاثمائة و ثماني و أربعون طفل (%90.86) شُخصوا قبل عيد ميلادهم الأول.استنتج من البحث بأنه يمكننا المساعدة في تقليل حالات التخلف العقلي بممارسة طرق الوقاية الأولية و الثانوية من خلال تحسين الواقع الصحي و التغذوي للمجتمع و التشخيص المبكر و معالجة الأمراض القابلة للعلاج من خلال تشريع قانون غربلة حديثي الولادة لتشخيص بعض الأمراض مثل نقص هرمون الغدة الدرقية, كالكتو سيميا وفقر الدم المنجلي

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Article
Is High Tissue Transglutaminase Antibody Titers Enough to Diagnose Celiac Disease in Children?

Author: Zuhair M. Al-Musawi
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2010 Volume: 3 no.3, 4 Issue: 7 Pages: 860-866
Publisher: Kerbala University جامعة كربلاء

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Abstract


Background. The current standard method for diagnosis of celiac disease (CD) is an adequate small-bowel biopsy (usually obtained through upper gastrointestinal tract endoscopy) showing characteristic histopathological changes, followed by a therapeutic response to a gluten free diet. Commercially available IgA tissue trassglutaminase antibody (TTG) screening tests have been developed with variable sensitivities and specificities. The use of high titer cutoff values than currently recommended should improve the specificity of the test and its positive predictive value.
Objectives. To evaluate the significance of high TTG titers in the diagnosis of CD.
Methods. One hundred sixteen patients with signs and symptoms suggestive of CD had undergone TTG testings (IgA &IgG class) and small-bowel biopsies while 50 healthy volunteers without family history of CD, were sent for TTG testings only. Ten patients excluded from the study because their TTG values and small-bowel biopsies were negative.
Results. Ninety eight of 106 zpatients demonstrated positive biopsy results. Seventy two of 106 patients had IgA TTG levels of >100U/ml, with 70 of 72 exhibiting positive biopsy Results. Twenty two of 28 patients with IgA TTG values >18-100U/ml exhibited positive biopsy results. Six patients with negative IgA TTG levels of ≤18 U/ml had positive biopsies and positive IgG TTG levels (>18 U/ml).Two volunteers had positive IgA TTG levels (>18U/ml).The sensitivity and specificity of IgA TTG were 94.3% and 96% respectively while the sensitivity of duodenal biopsy was 92.6%(8 symptomatic patients had negative small-bowel biopsy while their IgA TTG values were positive).
Conclusions. Symptomatic patients with high titer TTG levels >100 U/ml can be treated as CD without small-bowel biopsy and a negative biopsy does not exclude CD.
Key words. Celiac Disease; Tissue Transglutaminase Antibody; Small-Bowel Biopsy.
Abbreviations. CD, Celiac Disease; TTG, Tissue Transglutaminase Antibody.


Article
The sensitivity of urine microscopy in the diagnosis of urinary tract infection in children below 5 years

Author: Zuhair M.Al-Musawi
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2005 Volume: 1 Issue: 2 Pages: 27-32
Publisher: Al-Qadisiyah University جامعة القادسية

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Article
The Role of Serial Serum C-Reactive Protein in the Diagnosis and Duration of Antibiotic Therapy in Neonatal Sepsis

Author: Zuhair M. Al-Musawi
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2008 Volume: 11 Issue: 2 Pages: 33-40
Publisher: University of Kufa جامعة الكوفة

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Abstract

ABSTRACTBackground : the management of neonatal sepsis(N.S.) especially in developing countries is problematic. There is no single reliable marker of infection available at the present. C-reactive protein (CRP) has long been used as a marker of infection. Serial measurements of CRP are recommended as a guide for duration of antibiotic therapy. Objective : to evaluate the serial CRP measurements as a guide line for diagnosis and monitoring therapy and determining the duration of antibiotic treatment in suspected neonatal sepsis.Methods : Two hundreds neonates with clinical diagnosis of neonatal sepsis (patients group) and 200 neonates admitted or visited the outpatient clinic of the hospital for causes other than neonatal sepsis (control group) were enrolled in this prospective study. Blood culture & serial CRP were done for all patients group while single CRP was done for control group.Results : Of 200 infants (patients group), 90 (45%) had positive blood culture. CRP was negative on first and third day in 54 neonates (27%) of patients group while it was positive in 8 neonates (4%) of control group. CRP had sensitivity of (73%) and specificity of (96%). It's positive predictive value was (94.8%) whereas it's negative predictive value was (78%).Conclusion : single negative CRP value does not exclude N.S. and two negative CRP values, 24 hours apart can exclude the probability of N.S. and allow pediatricians to discontinue antibiotics.

الخلفية : تشخيص و علاج الأنتان ألوليدي و خصوصاً في الدول النامية صعب و لا يوجد فحص موثوق به للاستدلال على الإصابة في الوقت الحاضر. بروتين c التفاعلي لطالما استخدم كعلامة للإنتان يوصى بقياس البروتين c التفاعلي المتسلسل كدليل للتشخيص وتحديد فترة العلاج بالمضادات الحيوية.الهدف : تقييم قياس البروتين c التفاعلي كدليل لتشخيص و مراقبة و تحديد فترة العلاج بالمضادات الحيوية للانتا ن ألوليدي.الطرق :200 طفل حديث الولادة مشخص سريريا كانتان وليدي (مجموعة المرضى) و 200 طفل حديث الولادة ادخل المستشفى أو زار العيادة الخارجية لأسباب أخرى (المجموعة الضابطة) أشركوا في هذه الدراسة المستقبلية. زرع الدم و فحص البروتين c التفاعلي اجري لكافة الأطفال في مجموعة المرضى بينما اجري فحص البروتين c التفاعلي مرة واحدة لأطفال المجموعة الضابطة.النتائج : من 200 طفل حديث الولادة (مجموعة المرضى). 90 (45%) كان زرع الدم موجباً. فحص البروتين c التفاعلي كان سالبا ً في اليوم الأول و الثالث عند 54 (27%) طفل حديث الولادة في مجموعة المرضى بينما كان الفحص موجبا ً لدى 8 أطفال (4%) من ألمجموعه الضابطة. فحص البروتين c التفاعلي يملك درجة حساسية 73% و درجة نوعية 96% بينما قيمته التنبئية الموجبة 94.8% و قيمته التنبئية السالبة 78%.الاستنتاج : فحص واحد للبروتين c التفاعلي لا ينفي الإصابة بالانتان ألوليدي بينما فحصان سالبان ليومين متتالين يستبعدان الإصابة بالإنتان ألوليدي و يمكن الطبيب المعالج من إيقاف المضادات الحيوي


Article
The in Vitro Effect of Chloramphenicol and Salicylate on Erythrocytes of Patients with Favism

Authors: Zuhair M. Al-Musawi --- Mohammad Sh. Ali --- Ahmmed H. Matloob
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 1 Pages: 95-100
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Glucose 6-phosphate dehydrogenase (G6PD) deficiency is the most common of all clinically significant enzyme defects. A long list of drugs thought to cause haemolysis in patients with this enzyme defect.OBJECTIVE:To determine whether chloramphenicol and salicylate can act as in vitro exogenous oxidizing agents and subsequently cause haemolysis of G6PD deficient erythrocytes and matching the result with the data obtained from the clinical observations which includes the intake of trimethoprim-sulfamethoxazole, salicylate or nalidixic acid by favic patient.PATIENTS AND METHODS:Sixty six patients admitted to the hospital (Karbala teaching hospital for Children, Karbala, Iraq) with history of sudden onset of pallor and dark urine after fava beans ingestion were studied. Each patient was fully examined and his parents were asked about the type of fava beans ingested and the past drug history.Of the sixty six patients, ten were evaluated 1-3 months later and blood samples were taken from them along with blood samples from ten healthy volunteers. Blood samples from both groups were incubated in vitro with chloramphenicol and salicylate separately.RESULTS:Mean (SD) of methaemoglobin concentrations at baseline and after incubation with therapeutic and toxic concentrations of chloramphenicol (15 μg/ml and 25 μg/ml) and salicylate ( 150 μg/ml and 300 μg/ml) were calculated for both the control and the study groups. Paired t-test showed no significant differences (P> 0.05) in methaemoglobin concentrations at baseline and after incubation with therapeutic and toxic concentrations of these drugs. Mean percentage differences from baseline for G6PD deficient group were not significantly different from control group at both concentrations of these drugs as tested by student t-test.CONCLUSION: Hemolysis in G6PD deficient patients occurs mainly after fresh fava beans ingestion. chloramphenicol and acetylsalicylic acid do not cause significant hemolysis in G6PD deficient erythrocytes in vitro


Article
Patterns of Sensitization to Inhalant Allergens among Asthmatic Children in Karbala Province

Authors: Mohammad R. I. Ghazal --- Zuhair M. Al-Musawi --- Haidar A. N. Abood*,
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2013 Volume: 6 Issue: 2 Pages: 1630-1636
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: The patterns of sensitization to inhalant allergens among asthmaticchildren varies greatly in different countries. The detection of sensitization to inhalantallergens in asthmatic patients is used primarily to establish the diagnosis of allergicasthma. Also it is helpful in reducing asthma exacerbations through allergen exposureavoidance.Objectives: This study aims to determine the most common inhalant allergens associatedwith childhood asthma in Karbala province using allergen-specific IgE immunoassay.Patients and Methods: The present study was conducted in Karbala Teaching Hospital forChildren on 75 asthmatic children with elevated total serum IgE levels. All patients werescreened for the presence of specific IgE against inhalant allergens most frequently involvedin childhood asthma using EUROLINE Pediatric Inhalation IgE test kit that include 20inhalant allergens. The position of the band was used to determine the specific allergen whilethe color intensity of the band was used as predictive for the specific IgE concentration inserum samples.Results: Among 75 patients screened for specific IgE, 60 patients (80%) were sensitized to atleast one allergen and allergen-specific IgE was not detected in 15 (20%) patients. 30% ofsensitized patients, were sensitized to single allergen and 70% were sensitized to multipleallergens. Cat allergen was found in 60% of sensitized patients followed by European housedust mite allergen (55%). However, dog and aspergillus fumigatus allergens accounted for45% and 33.3% respectively. Most patients sensitized to cat and dog allergens (55.5% and52% respectively) showed clear bands signal intensity (moderate allergen-specific IgEconcentration). However the majority of patients sensitized to other inhalant allergensshowed weak bands signal intensity (low allergen-specific IgE concentration).Conclusions: Animal allergens (mostly cat) are the predominant inhalant allergens associatedwith childhood asthma in Karbala province with relatively higher allergen-specific IgEconcentrations than house dust mite and fungal allergens.


Article
Assessment of Asthma Severity by History and Lung Function Study in School Age Children

Authors: Zuhair M. Al Musawi --- Akeel Mahdi --- Majeed Matrood --- Haidar A. N. Abood
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2017 Volume: 10 Issue: 1 Pages: 2607-2612
Publisher: Kerbala University جامعة كربلاء

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Abstract

Background: The assessment of childhood asthma severity is important for the diagnosis and determining the initial level or step of the treatment of childhood asthma. It can be performed either by history alone for children less than five years old or by history and pulmonary function test for older children.Objective: to evaluate and compare the utility of history and lung function test in the assessment of asthma severity in childrenPatients and Method: Across-sectional study was conducted in Karbala teaching hospital of pediatrics, during the period from October 1, 2013 - April 30, 2014. The study included 50 children of both genders diagnosed with asthma (diagnosis made by consultant pediatrician). A questionnaire was designed for the assessment of asthma severity by history which included symptoms frequency over the preceding 4 weeks respectively. The lung function test was only done in children 6-year-old and more. All children in our study had performed lung function test.Results: The mean age of studied group was 9.6 ± 2.5. The result of asthma severity assessment based on history was as follow: 14/50 patients (28%) had intermittent asthma, 36/50 (72%) had persistent asthma of different degrees, mild in 11/50 (22%), moderate in 19/50 (38%) and severe persistent asthma in 6/50 (12%). While according to lung function test, 12/50 patients (24%) had intermittent asthma, 15/50 (30%) had mild persistent, 19/50 (38%) had moderate persistent and the remaining 4/50 patients (8%) had severe persistent asthma. There was no significant statistical difference in severity assessment between the two methods (P > 0.05).Conclusions: Our study shows good correlation between history and lung function test regarding classification of childhood asthma severity. History is an excellent tool for the assessment of childhood asthma severity when lung functions test is unavailable or difficult to be done in younger children.


Article
Macrophage Activation Syndrome in a Child with Systemic Juvenile Rheumatoid Arthritis

Authors: Ali M. Al- Yasry --- Jalal A. Ashoor --- Intisar H. Al- Kurdi --- Sabah N. Al-Musawi --- et al.
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2007 Volume: 1 no.2 Issue: 1 Pages: 170-173
Publisher: Kerbala University جامعة كربلاء

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Abstract

Macrophage activation syndrome (MAS) is a rare and potentially fatal complication of rheumaticdisorders in children; we describe a 14-month old boy in whom MAS developed as first presentation ofsystemic juvenile rheumatoid arthritis (S-JRA). He suffered from fever, bleeding tendency from mouth,gastro-intestinal tract, ecchymosis & site of injections followed by bilateral wrist swellings. Physicalexamination revealed cervical lymphadenopathy & hepatosplenomegaly. Laboratory findings wereabnormal liver enzymes, coagulopathies resembling disseminated intravascular coagulation, anemia,thrombocytopenia and abnormal C.S.F. findings.Up to the best of my knowledge this could be the first MAS associated with S-JRA in Iraq.Key words: Macrophage Activation Syndrome, Arthritis, Juvenile Rheumatoid

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Article
Total Serum IgE Level in Relation to Some Risk Factors of Childhood Asthma
مستوى المصل الكلي للغلوبيولين المناعي نوع E وعلاقته ببعض عوامل خطورة الإصابة بالربو عند الأطفال

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Measurement of total serum IgE (TSIgE) levels in asthmatic children can be used for supporting the diagnosis of allergic asthma, predicting asthma severity and monitoring response to therapy. Elevated TSIgE level is important risk factor for persistent childhood asthma. The present study aims to determine the extent of elevation in TSIgE levels among asthmatic children and its association with some risk factors of childhood asthma. This cross sectional study was conducted in Kerbala Teaching Hospital for Children on 154 asthmatic children. An interview was conducted with patients (including their parents) through a questionnaire prepared for this purpose to report patient's information and clinical data. All patients were screened for the presence of elevated TSIgE by a qualitative method followed by quantitative measurement of TSIgE concentration. Absolute eosinophils count was also determined. Seventy five (48.7%) patients showed positive IgE screening test and 79 (51.3%) patients showed negative IgE screening test. 61.4% of asthmatic children in the age group 5-10 years and 55.5% of patients in the age group >10 years were IgE (+ve), while only 33.3% of patients in the age group <5 years were IgE (+ve). The mean TSIgE level was 874.97±1323.85 IU/ml for IgE (+ve) patients (56% had levels <500, 21.3% between 500-1000, and 22.7% >1000 IU/ml) and 38.19±19.23 IU/ml for IgE (-ve) patients. The ages of patients in the IgE (+ve) group were significantly higher (P<0.01) than those for patients in the IgE (-ve) group. No significant differences (P>0.05) were observed between patients in both groups regarding absolute eosinophils count, patient's weight, gender, positive personal history of atopic dermatitis and/or allergic rhinitis, positive family history of asthma and exposure to smoking . In conclusion, there is high association between age and TSIgE levels in asthmatic children, with elevated levels mostly seen in older children. No association present between elevation in TSIgE and other risk factors for childhood asthma like; male gender, positive family history of asthma, exposure to tobacco smoke and peripheral blood eosinophilia.

إن قياس مستوى المصل الكلي للغلوبيولين المناعي نوع E (IgE) في الأطفال المصابين بالربو يستخدم في دعم تشخيص الربو التحسسي بالإضافة لتحديد شدة المرض ورصد الاستجابة للعلاج. يعتبر ارتفاع مستوى المصل الكلي للغلوبيولين المناعي نوع E أحد عوامل الخطورة المهمة للإصابة بالربو عند الأطفال. .إن الهدف من هذه الدراسة هو تحديد مدى الارتفاع في مستويات المصل الكلي للغلوبيولين المناعي نوع E بين الأطفال المصابين بالربو وارتباطه مع بعض عوامل خطورة الإصابة بالربو عند الأطفال. أجريت هذه دراسة في مستشفى كربلاء التعليمي للأطفال على 154 طفل مصاب بالربو. بعد مقابلة المرضى وملئ الاستمارات الخاصة بالدراسة, تم إجراء الفحص النوعي على أمصال المرضى لتحديد وجود مستويات مرتفعة من الغلوبيولين المناعي نوع E تلاها قياس كمي لتركيز الغلوبيولين المناعي نوع E في المصل و كذلك تم حساب العدد المطلق لكريات الدم البيضاء الحمضية لجميع المرضى. أظهرت الدراسة أن 48.7٪ من المرضى لديهم مستويات مرتفعة من الغلوبيولين المناعي نوع E (IgE+ve) بينما 51.3٪ كانت لديهم مستويات طبيعيــــــــة (IgE-ve). كانت المستويات مرتفعة في 61.4٪ من المرضى في الفئة العمرية (5-10 سنوات), 55.5٪ من المرضى في الفئة العمرية (أكثر من 10 سنوات) و 33.3٪ من المرضى في الفئة العمرية (أقل من 5 سنوات). إن متوسط مستوى المصل الكلي للغلوبيولين المناعي نوعE هو 874.97 ± 1323.85 وحدة دولية لكل مليليتر في المجموعة مرتفعة المستوى (56٪ لديهم مستويات أقل من 500، 21.3٪ بين 500-1000، و 22.7٪ أكثر من 1000 وحدة دولية / مل) و38.19 ± 19.23 وحدة دولية لكل مليليتر في المجموعة طبيعية المستوى. كانت أعمار المرضى في المجموعة مرتفعة المستوى (IgE+ve) أعلى إحصائيا من أعمار المرضى في المجموعة طبيعية المستوى (IgE-ve). لم تلاحظ أي فروقات ذات دلالة إحصائية بين المرضى في كلا المجموعتين فيما يتعلق بالعدد المطلق لكريات الدم البيضاء الحمضية، الوزن، الجنس، التهاب الجلد التأتبي أو التهاب الأنف التحسسي، إصابة أحد أفراد العائلة بالربو و التعرض للتدخين. من ذلك نستنتج ارتباط ارتفاع مستوى المصل الكلي للغلوبيولين المناعي نوع E بالعمر لدى الأطفال المصابين بالربو حيث تكون المستويات مرتفعة في الغالب في الأطفال الأكبر سنا. وعدم وجود علاقة بين ارتفاع مستوى المصل الكلي للغلوبيولين المناعي نوع E مع عوامل الخطورة الأخرى للإصابة بالربو عند الأطفال مثل جنس الذكور، التاريخ العائلي الإيجابي للربو،التعرض لدخان التبغ وارتفاع نسبة كريات الدم البيضاء الحمضية في الدم.

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